Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | OS10461 | FL |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | OS10461 | FL |
NPI | 1073714333 |
---|---|
Provider Name | Dana R Desser |
First Address | Wellington, FL 33414-3186 |
Second Address | Wellington, FL 33414-6135 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2007 |
Last Update Date | 13/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001098100 | (05) | FL |